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Management of Shock

Posted by: Philip Alex | Posted on: September 6th, 2008 | 0 Comments

Presented at the Northern Chapter of the Association of Surgeons of India at Sarabai on the 5th September 2008.

Basic concepts on the management of shock together with recent thinking on hypovelemic shock and trauma.

Multitasking in a Mission set up

Posted by: Philip Alex | Posted on: January 27th, 2008 | 2 Comments


Drudgery or devotion?- from “My Utmost for His Highest”, June 15th

Posted by: Philip Alex | Posted on: June 14th, 2006 | 0 Comments


"And beside this . . . add . ." 2 Peter 1:5

You have inherited the Divine nature, says Peter (v.4), now screw your attention down and form habits, give diligence, concentrate. "Add" means all that character means. No man is born either naturally or supernaturally with character, he has to make character. Nor are we born with habits; we have to form habits on the basis of the new life God has put into us. We are not meant to be illuminated versions, but the common stuff of ordinary life exhibiting the marvel of the grace of God. Drudgery is the touchstone of character. The great hindrance in spiritual life is that we will look for big things to do. "Jesus took a towel . . . and began to wash the disciples’ feet."

There are times when there is no illumination and no thrill, but just the daily round, the common task. Routine is God’s way of saving us between our times of inspiration. Do not expect God always to give you His thrilling minutes, but learn to live in the domain of drudgery by the power of God.

It is the "adding" that is difficult. We say we do not expect God to carry us to heaven on flowery beds of ease, and yet we act as if we did! The tiniest detail in which I obey has all the omnipotent power of the grace of God behind it. If I do my duty, not for duty’s sake, but because I believe God is engineering my circumstances, then at the very point of my obedience the whole superb grace of God is mine through the Atonement.

Embryonal rhabdomyosarcoma of the prostate in a 19 year old

Posted by: Philip Alex | Posted on: May 27th, 2006 | 0 Comments

A 19 year old boy presented to us with edema, difficulty in passing urine and a pelvic mass extending till the umbilicus. He had this for the past six months, and had been to Lucknow once to be treated with little benefit. He apparently had received two cycles of chemotherapy there with again, little benefit.

A per rectal exam revealed a hard mass anteriorly pushing the rectum backwards. A CT scan revealed bilateral hydronephrosis with a large mass in the prostatic region invading the bladder and pushing the rectum back. The large mass was the bladder.

A prostatic biopsy revealed embryonal rhabdomyosarcoma prostate.

His preop creatinine was 3.2mg%. He underwent a trocar suprapubic cystostomy to drain and decompress his obstructed system. After his creatinine had decreased to 1.7mg% he underwent exploration, total cystectomy, prostatectomy, pelvic node dissection, and bilateral ureteric reimplantation into an ileal conduit.

By the grace of God he is now doing well postoperatively and will be scheduled for post op chemotherapy.

Ascariasis causing intestinal obstruction

Posted by: Philip Alex | Posted on: May 22nd, 2006 | 0 Comments

A four year old boy presented with history of not passing stool or flatus for three days and vomiting a worm.

On examination he was dehydrated, and had abdominal distension with features of intestinal obstruction.

A plain x

Easter – the day before

Posted by: Philip Alex | Posted on: April 15th, 2006 | 0 Comments

Imagine the day after Good Friday. The disciples would have seen Jesus on the cross and watched him die. They would have also watched their hopes and dreams die. Memories of their times together, the way He made their hearts burn. He had

Torted Para- uterine leiomyoma

Posted by: Philip Alex | Posted on: August 2nd, 2005 | 0 Comments

A 58 year old lady presented with the history of excruciating abdominal pain for two days. She had no pain before that and was not aware of a mass in her abdomen.

On examination she was well nourished, not pale, and not febrile. She had a huge mass arising from the pelvis upto her umbilicus, filling the lower abdomen. It was firm, not tender and non mobile. It appeared continuous with the uterus.

An ultrasound showed a mass from the pelvis, adjacent to the uterus, separate from the ovaries, with cystic degenaration.

She was taken up for a laparotomy when a torted para uterine leiomyoma was found with cystic degenaration. She did well post operatively.


Posted by: Philip Alex | Posted on: July 27th, 2005 | 0 Comments

Foreign body bronchus removal with a working nephroscope

Presented in the


Posted by: Philip Alex | Posted on: July 27th, 2005 | 0 Comments

Submitted for the Association of Rurual Surgeons conference in Ujjain, September 2005KEYWORDS: SUMMARY:

Total cystourethrectomy and ureteric reimplantation is a major procedure in any institution. We present one case operated in our rural hospital.

A 58 year old lady presented to our hospital in August last year with a periurethral growth and urinary retention. She underwent a local excision biopsy which was reported as periurethral squamous cell carcinoma. She was referred to a teaching institution in a major city. She represented to us six months later with a recurrent mass and the report of being given a date for surgery after eight months. She underwent a total cystourethrectomy and ureteric reimplantation in our institution with excision of a groin node. She stood the surgery well and is now symptom free and without detectable disease after three months. She is on regular follow up. The specimen showed clear tumour margins.


Major oncologic and reconstructive surgery is seldom undertaken in the rural hospital. We present one case which had returned from the tertiary institution with nothing constructive done for her which we decided to operate in our hospital. She has done well postoperatively. Major surgery can be undertaken safely and in the best interest of the patient who has either no access to specialized care or has returned without constructive benefit from the tertiary care institution.


Posted by: Philip Alex | Posted on: July 15th, 2005 | 0 Comments


Phytobezoars and unusual causes of luminal intestinal obstruction are well documented in both adult and pediatric patients. Most bezoars occur in patients who are mentally challenged. Luminal obstruction has been associated with carcinoid of the ileum. We report a case where a patient had swallowed approximately fifty cherries with the pips under the mistaken impression that it would cure her diabetes.


A 35 year old lady, a known diabetic on treatment was brought to our hospital ketotic, with a blood sugar of 547mg%. She was tachynpoeic, and comatose. She had complained of abdominal pain and her relatives had mentioned that she had eaten quite a few cherries that day. She was intubated, resuscitated, started on an insulin glucose infusion. Her blood sugar levels gradually decreased to 229 over the next 8 hours. She was tender in the abdomen. Abdominal x rays did not reveal any abnormality. She was taken up for a laparotomy twelve hours after her presentation. On laparotomy about fifty cherry pips were found causing luminal obstruction at the terminal ileum from sheer mass effect. They were milked into the colon through the ileocaecal valve, upon which the obstruction was relieved. She made an uneventful recovery. On questioning, she admitted to having eaten these cherries on the assumption that this would cure her diabetes.


Intestinal obstruction is a common medical problem and accounts for a large percentage of surgical admissions for acute abdominal pain. Small intestinal ileus is the most common form of intestinal obstruction; it occurs after most abdominal operations and is a common response to acute extra-abdominal medical conditions and intra-abdominal inflammatory conditions. Mechanical small bowel obstruction is somewhat less common; such obstruction is secondary to intra-abdominal adhesions, hernias, or cancer in about 90% of cases. Mechanical colonic obstruction accounts for only 10% to 15% of all cases of mechanical obstruction and most often develops in response to obstructing carcinoma, diverticulitis, or volvulus.

Among secondary causes of small bowel obstruction the most common cause remains postoperative adhesive obstruction. Various other causes have been described and rigorous work up and evaluation have been described. Acute intraluminal occlusions have been less frequent, and the subject of varied case reports. Among them bezoars are the most common, usually in patients with depressive illness and psychiatric illness., Other rare causes of intestinal occlusions have been described, among which are enteroliths occurring with jejunal diverticulae, undigested food, including a green chilly, anasakiasis and small bowel haemangioma. Bezoars have been described with undigested food and vegetable matter serving as nuclei. Bezoars of vegetable matter causing obstruction have been described in the pediatric population, with cherry tomato pips and grape seeds serving as bezoars., Carcinoids of the ileocaecal area have been associated with ten fruit pip bezoars in an adult. We describe probably the first case report of an en masse obstruction caused by fifty cherry fruit pip bezoars without antecedent obstructive cause. The sheer volume of the number of pips probably caused the obstruction. We recommend milking them beyond the ileocecal valve without the necessity for an enterotomy.